Published online: 01/04/2016
Published print:04/2016
ORIGINAL PAPER doi: 10.5455/medarh.2016.70.112-115
Med Arch. 2016 Apr; 70(2): 112-115 Received: JAN 25, 2016 | Accepted: MAR 16, 2016
© 2016 Mehmet Sargin, Mehmet Selcuk Uluer, Eyüp Aydogan, Bülent Hanedan, Muhammed İsmail Tepe, Mehmet Ali Eryılmaz, Emre Ebem, and Sadık Özmen This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Anxiety Levels in Patients Undergoing Sedation for Elective Upper Gastrointestinal Endoscopy and Colonoscopy Mehmet Sargin1, Mehmet Selcuk Uluer1, Eyüp Aydogan1, Bülent Hanedan1, Muhammed İsmail Tepe1, Mehmet Ali Eryılmaz2, Emre Ebem1, and Sadık Özmen1 Konya Training and Research Hospital, Anesthesiology and Reanimation Department, Konya, Turkey 2 Konya Training and Research Hospital, General Surgery Department, Konya, Turkey 1
Corresponding author: Mehmet Sargin, MD, Konya Training and Research Hospital, Anesthesiology and Reanimation Department, Konya, Turkey, Phone +905322662766, Fax +903323236723, [email protected]
ABSTRACT Background: Anxiety is a common preprocedural problem and during processing especially in interventional medical processes. Aim: Aim of this study was to assess the level of anxiety in patients who will undergo upper gastrointestinal endoscopy and coloscopy. Methods: Five hundred patients scheduled to undergo sedation for elective upper gastrointestinal endoscopy and colonoscopy were studied. Beck Anxiety Inventory (BAI) was administered to each patient before brought to the endoscopy room. Demographic data of patients were collected. Results: BAI scores and anxiety levels were significantly lower in; males compared to females, patients with no comorbidity compared to patients with comorbidity (both P values < 0.001). BAI scores were significantly lower in patients educational status university and upper compared to patients educational status primary-high school (p=0.026). There were no significant difference between BAI and anxiety levels compared to procedures (Respectively, P=0.144 P=0.054). There were no significant difference between BAI scores and anxiety levels compared to age groups (Respectively, P=0.301 P=0.214). Conclusions: We think that level of anxiety in patients who will undergo upper gastrointestinal endoscopy and colonoscopy was effected by presence of comorbidities and gender but was not effected by features such as age, procedure type and educational status. Key words: Anxiety, sedation, upper gastrointestinal endoscopy, colonoscopy.
1. INTRODUCTION
However endoscopy is the golden standard of gastrointestinal system examination and treatment of gastrointestinal system diseases, painfulness and discomfort of procedure makes the process for both appliers and the ones who was applied (1, 2). As a result, acceptance of this procedure may cause major anxiety usually. Anxiety is a common problem in patients undergoing interventional medical procedures. Because of this reason, sedo-analgesia demand on endoscopic procedures has been increased. Sedation for upper gastrointestinal endoscopy and colonoscopy not only improves patient tolerance and satisfaction but also increases
112
the willingness of patients to return for repeated procedures (3). Despite this, gastrointestinal endoscopy and colonoscopy are still accepted as invasive procedures with the potential for discomfort, embarrassment and disappointment related to unexpected findings. These concerns can result in anxiety that unfavorably decreases patient cooperation and satisfaction with the gastroscopic or colonoscopic procedure (4). It was reported that features such as age and gender may effect the anxiety (5). Different types of anxiety scales were preferred in patients who will undergo upper gastrointestinal endoscopy and colonoscopy. (6, 7). Beck Anxiety Inventory has a wide-
Original paper | Med Arch. 2016 Apr; 70(2): 112-115
Efficiency of Local Antiseptic Alkosol
spread use in this subject. Determination, alleviation and elimination of anxiety is important for not just unwanted and discomfortable conditions, it is also important that anxiety extends, complicate the procedure and increases complications (8). For the alleviation of anxiety, many techniques such as information and music playback before the various invasive procedures has been tried (9, 10). But, it is important for the efficiency of these techniques to determinate the anxiety levels and potential risk groups for anxiety. Aim of this study was to assess the level of anxiety in patients who will undergo upper gastrointestinal endoscopy and colonscopy, and the relationship between anxiety and individual and social features of these patients.
2. PATIENTS AND METHODS
Institutional ethics committee approval and written consent from the patients were obtained for the study. Five hundred patients between the ages of 18-80 years, ASA physical status I, II and III, scheduled to undergo sedation for elective upper gastrointestinal endoscopy and colonoscopy were studied. Patients were excluded if they were declined conscious sedation or had previously undergone sedation for elective upper gastrointestinal endoscopy and colonoscopy. Other exclusion criteria included: patient age below 18 or above 80 years, physical inability to participate, hearing problems due to any cause, any overt or borderline psychiatric illnesses, senile dementia and treatment with anxiolytic medication in the last 72 hours prior to examination. Beck Anxiety Inventory (11) was administered to each patient before brought to the endoscopy room. This is a 21-item self-report questionnaire in which the respondent is asked to rate how much each symptom has bothered him/her over the week leading up to the procedures. The symptoms are rated on a four-point scale, ranging from ‘not at all’ [0] to ‘severely’ [3]. The values for each item are summed yielding a total score ranging between 0 and 63 points. A Beck score of 0-7 represents a minimal level of anxiety, 8-15 mild, 16-25 moderate and 26-63 severe anxiety. No sedative premedication was employed before the procedure. Demographic data of patients including age, gender, comorbidities, height, weight, body mass index and educational status, were collected. The procedure was also recorded. Statistical analyses were performed with SPSS 15.0 software. Parametric data were tested with Student’s t test and One-way ANOVA presented as median, interquartile range (IQR) and range, accordingly. Categorical data were analyzed with the two-tailed Pearson’s x2 test and are given as numbers and proportions. A P-value less than 0.05 was considered statistically significant. If Bonferroni correction used P-value less than 0.01 was considered statistically significant.
3. RESULTS
Data were collected for all 500 enrolled patients. Patients’ characteristics for 500 patients data are summarized in Table 1. Values are expressed as median (IQR [range]), number or number (proportion).
Original paper | Med Arch. 2016 Apr; 70(2): 112-115
Age (year) Gender (M: F) Height (cm) Weight (cm) Body mass index (kg/m2) Comorbidities (yes: no) Educational status (Primary-High school: University and upper) Procedure (Upper GI endoscopy: colonoscopy: both) Beck Score Anxiety Levels (Minimal, mild, moderate, severe)
42.00 (41.07-43.73 [18-80]) 180 (% 36) : 320 (% 64) 165.00 (163.71-165.20 [145192]) 70.50 (71.04-73.77 [36-151]) 26.20 (26.32-27.34 [15.4352.03]) 163 (% 32.6) : 337 (% 67.4) 447 (% 89.4) : 53 (% 10.6) 391 (% 78.2) : 74 (% 14.8) : 35 (% 7) 7.00 (7.61-8.89 [0-57]) 274 (%54.8) : 153 (%30.6) : 55 (%11.0) : 18 (%3.6)
Table 1. Patients’ characteristics for 500 patients. Values are as median (IQR [range]), number or number (proportion).
Comparison of Beck Anxiety Inventory scores and demographic data by gender are summarized in Table 2. Beck Score
Anxiety Levels*
Age (year) Height (cm) Weight (cm) Body mass index (kg/m2) Comorbidities (yes:no) Educational status** Procedure***
Male (n=180) 4.00 (4.39-5.89 [0-37])
Female (n=320) 9.00 (9.15-10.85 [0-57]) 142 (%44.4) : 132 (%73.3) : 112 (%35.5) : 41 (%22.8) : 6 49 (%15.3) : 17 (%3.3) : 1 (%0.6) (%5.3) 41.50 (40.4742.00 (40.3945.24 [18-80]) 43.74 [18-80]) 170.00 (169.87- 160.00 (160.07161.5 [145172.01 [154192]) 187]) 74.00 (73.1669.50 (69.0377.42 [43-122]) 72.53 [36-151]) 25.19 (25.0727.05 (26.7426.48 [15.4328.10 [15.7941.52]) 52.03]) 140 (% 77.8) : 40 197 (% 61.6) : (% 22.2) 123 (% 38.4) 149 (% 82.8) : 31 298 (% 93.1) : 22 (% 17.2) (% 6.9) 126 (%70) : 40 265 (%82.8) : (%22.2) : 17 34 (%10.6) : 21 (%7.8) (%6.6)
p < 0.001
Published print:04/2016
ORIGINAL PAPER doi: 10.5455/medarh.2016.70.112-115
Med Arch. 2016 Apr; 70(2): 112-115 Received: JAN 25, 2016 | Accepted: MAR 16, 2016
© 2016 Mehmet Sargin, Mehmet Selcuk Uluer, Eyüp Aydogan, Bülent Hanedan, Muhammed İsmail Tepe, Mehmet Ali Eryılmaz, Emre Ebem, and Sadık Özmen This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Anxiety Levels in Patients Undergoing Sedation for Elective Upper Gastrointestinal Endoscopy and Colonoscopy Mehmet Sargin1, Mehmet Selcuk Uluer1, Eyüp Aydogan1, Bülent Hanedan1, Muhammed İsmail Tepe1, Mehmet Ali Eryılmaz2, Emre Ebem1, and Sadık Özmen1 Konya Training and Research Hospital, Anesthesiology and Reanimation Department, Konya, Turkey 2 Konya Training and Research Hospital, General Surgery Department, Konya, Turkey 1
Corresponding author: Mehmet Sargin, MD, Konya Training and Research Hospital, Anesthesiology and Reanimation Department, Konya, Turkey, Phone +905322662766, Fax +903323236723, [email protected]
ABSTRACT Background: Anxiety is a common preprocedural problem and during processing especially in interventional medical processes. Aim: Aim of this study was to assess the level of anxiety in patients who will undergo upper gastrointestinal endoscopy and coloscopy. Methods: Five hundred patients scheduled to undergo sedation for elective upper gastrointestinal endoscopy and colonoscopy were studied. Beck Anxiety Inventory (BAI) was administered to each patient before brought to the endoscopy room. Demographic data of patients were collected. Results: BAI scores and anxiety levels were significantly lower in; males compared to females, patients with no comorbidity compared to patients with comorbidity (both P values < 0.001). BAI scores were significantly lower in patients educational status university and upper compared to patients educational status primary-high school (p=0.026). There were no significant difference between BAI and anxiety levels compared to procedures (Respectively, P=0.144 P=0.054). There were no significant difference between BAI scores and anxiety levels compared to age groups (Respectively, P=0.301 P=0.214). Conclusions: We think that level of anxiety in patients who will undergo upper gastrointestinal endoscopy and colonoscopy was effected by presence of comorbidities and gender but was not effected by features such as age, procedure type and educational status. Key words: Anxiety, sedation, upper gastrointestinal endoscopy, colonoscopy.
1. INTRODUCTION
However endoscopy is the golden standard of gastrointestinal system examination and treatment of gastrointestinal system diseases, painfulness and discomfort of procedure makes the process for both appliers and the ones who was applied (1, 2). As a result, acceptance of this procedure may cause major anxiety usually. Anxiety is a common problem in patients undergoing interventional medical procedures. Because of this reason, sedo-analgesia demand on endoscopic procedures has been increased. Sedation for upper gastrointestinal endoscopy and colonoscopy not only improves patient tolerance and satisfaction but also increases
112
the willingness of patients to return for repeated procedures (3). Despite this, gastrointestinal endoscopy and colonoscopy are still accepted as invasive procedures with the potential for discomfort, embarrassment and disappointment related to unexpected findings. These concerns can result in anxiety that unfavorably decreases patient cooperation and satisfaction with the gastroscopic or colonoscopic procedure (4). It was reported that features such as age and gender may effect the anxiety (5). Different types of anxiety scales were preferred in patients who will undergo upper gastrointestinal endoscopy and colonoscopy. (6, 7). Beck Anxiety Inventory has a wide-
Original paper | Med Arch. 2016 Apr; 70(2): 112-115
Efficiency of Local Antiseptic Alkosol
spread use in this subject. Determination, alleviation and elimination of anxiety is important for not just unwanted and discomfortable conditions, it is also important that anxiety extends, complicate the procedure and increases complications (8). For the alleviation of anxiety, many techniques such as information and music playback before the various invasive procedures has been tried (9, 10). But, it is important for the efficiency of these techniques to determinate the anxiety levels and potential risk groups for anxiety. Aim of this study was to assess the level of anxiety in patients who will undergo upper gastrointestinal endoscopy and colonscopy, and the relationship between anxiety and individual and social features of these patients.
2. PATIENTS AND METHODS
Institutional ethics committee approval and written consent from the patients were obtained for the study. Five hundred patients between the ages of 18-80 years, ASA physical status I, II and III, scheduled to undergo sedation for elective upper gastrointestinal endoscopy and colonoscopy were studied. Patients were excluded if they were declined conscious sedation or had previously undergone sedation for elective upper gastrointestinal endoscopy and colonoscopy. Other exclusion criteria included: patient age below 18 or above 80 years, physical inability to participate, hearing problems due to any cause, any overt or borderline psychiatric illnesses, senile dementia and treatment with anxiolytic medication in the last 72 hours prior to examination. Beck Anxiety Inventory (11) was administered to each patient before brought to the endoscopy room. This is a 21-item self-report questionnaire in which the respondent is asked to rate how much each symptom has bothered him/her over the week leading up to the procedures. The symptoms are rated on a four-point scale, ranging from ‘not at all’ [0] to ‘severely’ [3]. The values for each item are summed yielding a total score ranging between 0 and 63 points. A Beck score of 0-7 represents a minimal level of anxiety, 8-15 mild, 16-25 moderate and 26-63 severe anxiety. No sedative premedication was employed before the procedure. Demographic data of patients including age, gender, comorbidities, height, weight, body mass index and educational status, were collected. The procedure was also recorded. Statistical analyses were performed with SPSS 15.0 software. Parametric data were tested with Student’s t test and One-way ANOVA presented as median, interquartile range (IQR) and range, accordingly. Categorical data were analyzed with the two-tailed Pearson’s x2 test and are given as numbers and proportions. A P-value less than 0.05 was considered statistically significant. If Bonferroni correction used P-value less than 0.01 was considered statistically significant.
3. RESULTS
Data were collected for all 500 enrolled patients. Patients’ characteristics for 500 patients data are summarized in Table 1. Values are expressed as median (IQR [range]), number or number (proportion).
Original paper | Med Arch. 2016 Apr; 70(2): 112-115
Age (year) Gender (M: F) Height (cm) Weight (cm) Body mass index (kg/m2) Comorbidities (yes: no) Educational status (Primary-High school: University and upper) Procedure (Upper GI endoscopy: colonoscopy: both) Beck Score Anxiety Levels (Minimal, mild, moderate, severe)
42.00 (41.07-43.73 [18-80]) 180 (% 36) : 320 (% 64) 165.00 (163.71-165.20 [145192]) 70.50 (71.04-73.77 [36-151]) 26.20 (26.32-27.34 [15.4352.03]) 163 (% 32.6) : 337 (% 67.4) 447 (% 89.4) : 53 (% 10.6) 391 (% 78.2) : 74 (% 14.8) : 35 (% 7) 7.00 (7.61-8.89 [0-57]) 274 (%54.8) : 153 (%30.6) : 55 (%11.0) : 18 (%3.6)
Table 1. Patients’ characteristics for 500 patients. Values are as median (IQR [range]), number or number (proportion).
Comparison of Beck Anxiety Inventory scores and demographic data by gender are summarized in Table 2. Beck Score
Anxiety Levels*
Age (year) Height (cm) Weight (cm) Body mass index (kg/m2) Comorbidities (yes:no) Educational status** Procedure***
Male (n=180) 4.00 (4.39-5.89 [0-37])
Female (n=320) 9.00 (9.15-10.85 [0-57]) 142 (%44.4) : 132 (%73.3) : 112 (%35.5) : 41 (%22.8) : 6 49 (%15.3) : 17 (%3.3) : 1 (%0.6) (%5.3) 41.50 (40.4742.00 (40.3945.24 [18-80]) 43.74 [18-80]) 170.00 (169.87- 160.00 (160.07161.5 [145172.01 [154192]) 187]) 74.00 (73.1669.50 (69.0377.42 [43-122]) 72.53 [36-151]) 25.19 (25.0727.05 (26.7426.48 [15.4328.10 [15.7941.52]) 52.03]) 140 (% 77.8) : 40 197 (% 61.6) : (% 22.2) 123 (% 38.4) 149 (% 82.8) : 31 298 (% 93.1) : 22 (% 17.2) (% 6.9) 126 (%70) : 40 265 (%82.8) : (%22.2) : 17 34 (%10.6) : 21 (%7.8) (%6.6)
p < 0.001
